Provider Demographics
NPI:1316223456
Name:JEAN-BAPTISTE, NICODEMME
Entity Type:Individual
Prefix:MR
First Name:NICODEMME
Middle Name:
Last Name:JEAN-BAPTISTE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:183 STERLING SPRINGS LN
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32714-3856
Mailing Address - Country:US
Mailing Address - Phone:407-775-9705
Mailing Address - Fax:
Practice Address - Street 1:183 STERLING SPRINGS LN
Practice Address - Street 2:
Practice Address - City:ALTAMONTE SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:32714-3856
Practice Address - Country:US
Practice Address - Phone:407-775-9705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-02
Last Update Date:2020-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLL11000120563246RP1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy